Skip to main content

Main menu

  • Content
    • Current Issue
    • Advance Access
    • Archive
    • Supplements
      • The Challenge Initiative Platform
      • Call for Abstracts
      • The Responsive Feedback Approach
    • Topic Collections
  • For Authors
    • Instructions for Authors
    • Submit Manuscript
    • Publish a Supplement
    • Promote Your Article
    • Resources for Writing Journal Articles
  • About
    • About GHSP
    • Editorial Team
    • Advisory Board
    • FAQs
    • Instructions for Reviewers
  • Webinars
    • Local Voices Webinar
    • Connecting Creators and Users of Knowledge
    • Publishing About Programs in GHSP
  • Other Useful Sites
    • GH eLearning
    • GHJournal Search

User menu

  • My Alerts

Search

  • Advanced search
Global Health: Science and Practice
  • Other Useful Sites
    • GH eLearning
    • GHJournal Search
  • My Alerts

Global Health: Science and Practice

Dedicated to what works in global health programs

Advanced Search

  • Content
    • Current Issue
    • Advance Access
    • Archive
    • Supplements
    • Topic Collections
  • For Authors
    • Instructions for Authors
    • Submit Manuscript
    • Publish a Supplement
    • Promote Your Article
    • Resources for Writing Journal Articles
  • About
    • About GHSP
    • Editorial Team
    • Advisory Board
    • FAQs
    • Instructions for Reviewers
  • Webinars
    • Local Voices Webinar
    • Connecting Creators and Users of Knowledge
    • Publishing About Programs in GHSP
  • Alerts
  • Visit GHSP on Facebook
  • Follow GHSP on Twitter
  • RSS
  • Find GHSP on LinkedIn
COMMENTARY
Open Access

Opportunities and Challenges of Delivering Postabortion Care and Postpartum Family Planning During the COVID-19 Pandemic

Anne Pfitzer, Eva Lathrop, Alison Bodenheimer, Saumya RamaRao, Megan Christofield, Patricia MacDonald, Bethany Arnold, Neeta Bhatnagar, Erin Mielke and Meridith Mikulich
Global Health: Science and Practice September 2020, 8(3):335-343; https://doi.org/10.9745/GHSP-D-20-00263
Anne Pfitzer
aJhpiego, Baltimore, MD, USA.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • For correspondence: anne.pfitzer@jhpiego.org
Eva Lathrop
bPopulation Services International, Washington, DC, USA.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Alison Bodenheimer
cUnited Nations Foundation, Washington, DC, USA.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Saumya RamaRao
dPopulation Council, New York, NY, USA.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Megan Christofield
aJhpiego, Baltimore, MD, USA.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Patricia MacDonald
eBureau for Global Health, United States Agency for International Development, Washington, DC, USA.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Bethany Arnold
aJhpiego, Baltimore, MD, USA.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Neeta Bhatnagar
aJhpiego, Baltimore, MD, USA.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Erin Mielke
eBureau for Global Health, United States Agency for International Development, Washington, DC, USA.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Meridith Mikulich
eBureau for Global Health, United States Agency for International Development, Washington, DC, USA.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
PreviousNext
  • Article
  • Figures & Tables
  • Supplements
  • Info & Metrics
  • Comments
  • PDF
Loading

Key Messages

We seek to assist decision makers in maximizing provision of essential services without compromising access to quality family planning care and while minimizing the risk of COVID-19 transmission among clients, and between clients and health care workers.

  • Managers should help facility teams to integrate counseling and provide a range of contraceptive methods as is feasible within existing contacts with pregnant, postabortion, birthing, and postpartum women, even as services migrate to new models with a mixture of in-person and virtual/tele-health consultations.

  • Policy makers should prioritize devoting resources to meet the family planning needs of pregnant, postabortion, birthing, and postpartum women, and the health care workers serving them as an investment against higher health systems burdens in later months and during subsequent waves of the pandemic.

Abstract

Le tableau et encadre de dialogue de l’article est aussi disponible en français.

INTRODUCTION

The coronavirus disease (COVID-19) pandemic is poised to cause infection and death in millions of people across the globe at a stunning pace.1 The scale of the required response will inevitably pivot attention and resources toward fighting the pandemic and away from essential reproductive, maternal, newborn, and child health care, including access to voluntary family planning in the critical postabortion and postpartum periods. Decreased access to these lifesaving services will lead to a downstream increase in maternal and child morbidity and mortality.2–4 Data from previous complex emergencies demonstrate that a decrease in access to family planning results in increased poor outcomes related to unintended pregnancies and abortions.5 In a pandemic as vast and unique as COVID-19, where the primary mitigating factor is elimination of close physical contact, harnessing opportunities to provide family planning education, services, and supplies while women are already interfacing with the health care system during pregnancy and the postabortion, childbirth, and postpartum periods is strategic and lifesaving. This will require acceleration of integrated service delivery as well as creative and dynamic innovations of alternative service delivery approaches to address the family planning needs of pregnant, postabortion, birthing, and postpartum women. Investment in documentation of programmatic learnings could offer insights and opportunities for improving the resilience of health systems. Devoting scarce health resources to ensure the family planning needs of pregnant, postabortion, birthing, and postpartum women are met during the first wave of the COVID-19 pandemic is an investment against higher health systems burdens in later months and during subsequent waves of the pandemic and a means to ultimately save lives and improve livelihoods.

Harnessing opportunities to provide FP education, services, and supplies while women are already interfacing with the health care system is strategic and lifesaving.

WHY FOCUS ON FAMILY PLANNING WITHIN SERVICES FOR PREGNANT, POSTABORTION, AND POSTPARTUM WOMEN NOW?

Closely spaced and unintended pregnancies are a public health concern and can have detrimental effects on women, infants, and children.6–9 The World Health Organization (WHO) recommends a 24-month interval from live birth until subsequent pregnancy to reduce the risk of adverse maternal, perinatal, and infant outcomes.10 Similarly, a woman who experiences a miscarriage or induced abortion that requires emergency treatment will rapidly return to fertility, with ovulation within 14–28 days depending on gestation.11 Thus, offering voluntary family planning counseling and services as part of postabortion care (PAC) as well as during pregnancy, childbirth, and the postpartum period is a critical means to protect vulnerable postpartum and postabortion women and reduce unintended and closely spaced pregnancies.12,13 Both postpartum and postabortion provision of voluntary contraceptive counseling and services constitute high-impact practices.14 In this commentary, we refer to the broad care of postabortion women as PAC, which includes15:

two essential services: (1) treatment of emergency complications, and (2) voluntary family planning counseling, including provision of contraception.

We use postabortion family planning (PAFP) when specifically referencing that component of PAC.

Before the COVID-19 pandemic, unmet need for modern contraception among women who wished to delay, space, or limit future childbearing and were not currently using a method in the postpartum and postabortion periods was already high.16–18 Because the COVID-19 pandemic has affected both supply- and demand-side access to family planning, women’s ability to achieve their reproductive intentions has been further compromised. Health systems worldwide seek to reduce facility visits to protect the health workforce and clients from the spread of COVID-19. Individuals’ health-seeking behavior is changing too, as they avoid facilities or seek care from alternate sources because of fear of acquiring the infection, respect for distancing measures, and/or mobility restrictions.

It is precisely here where postpartum family planning (PPFP) and PAFP offer a unique opportunity to make the most of facility and pharmacy visits and interactions with community health workers that individuals continue to have during the COVID-19 crisis. Now more than ever, and as others have already pointed out,19 the care that pregnant, postpartum, and postabortion women receive could be optimized to also meet their family planning needs by integrating contraceptive counseling and services for those who wish to space or limit their next pregnancy and to yield the significant health and well-being aims of voluntary contraceptive uptake and healthy timing and spacing of pregnancies.

PPFP and PAFP offer a unique opportunity to make the most of facility and pharmacy visits and interactions with community health workers that individuals continue to have during the COVID-19 crisis.

Thus, country health programs and facilities must prepare now and for the future to serve pregnant, postabortion, birthing, and postpartum women’s needs and to ensure women and their accompanying partners are informed, educated, and counseled on voluntary contraception. Although currently available guidelines center on infection prevention and control and immunization services, several international bodies have clarified the essential nature of family planning and maternal health care including the WHO (see these resources20 and these21).

PRACTICAL APPROACHES AND MODIFIED FAMILY PLANNING SERVICE DELIVERY MODELS FOR DIVERSE POSTABORTION AND POSTPARTUM CLIENTS

To facilitate a reduction in COVID-19 transmission without compromising the quality of voluntary PAFP and PPFP counseling and services, we must enhance safe delivery of existing integrated service models (drawing lessons from previous emergencies) and also implement innovative, alternative service delivery mechanisms.

The key pillars in WHO’s strategy to reduce human-to-human transmission that must be incorporated into these models include:

  1. Social distancing (e.g., supporting stay-at-home orders, limiting crowds in facilities, and reducing number of patient-provider contacts)

  2. Early identification and isolation of cases (e.g., systematic screening, contact tracing, and community-based referral pathways)

  3. Infection prevention and control (e.g., hand hygiene, appropriate personal protective equipment, and cleaning supplies)

We encourage countries to follow the WHO operational considerations22 for case management of COVID-19 and share WHO or locally adapted risk communication materials23 across all health sectors.

Health systems must confront rapidly changing challenges to maintain provision of essential health services, including PAC and PPFP. Overcoming these challenges will require a high level of intersectoral collaboration, communication, transparency, and community engagement. Specific obstacles will vary in number and magnitude by setting and may be particularly burdensome in already fragile settings. Early data highlight the high personal toll on health care workers (HCWs) during the pandemic in terms of their own physical health and risk of contracting the virus, mental health, structural concerns (availability/lack of personal protective equipment, long hours, etc.).24 Policy makers and program managers must identify which disruptions most significantly affect family planning outcomes so that limited resources can be allocated most effectively. These obstacles may include, but are not limited to:

  • Supply chain disruptions for family planning and infection prevention and control products (e.g., stock-outs)25

  • Clinic closures, reduced hours, and diminished capacity to treat high client volumes

  • Redeployment of skilled family planning health staff to COVID-19 response

  • HCW fear of contagion/contamination and attacks by community members

  • Client hesitancy to access public transportation; health facilities treating COVID-19 patients and other crowded facilities (e.g., pharmacies, waiting rooms)

  • Mobility or movement restrictions impacting clients and some cadres of the health workforce

  • Income loss among individuals and families to access or pay user fees for contraceptive services

  • Adoption of recommendations26 for limiting attendance of support people at in-person antenatal care (ANC), delivery, or postnatal visits; shifting of selected ANC visits to telehealth; and early postpartum discharge from facilities.

Policy makers and program managers must identify which disruptions most significantly affect family planning outcomes so that limited resources can be allocated most effectively.

On the last point, the recommendations inhibit or delay attributes of care in normal times, such as joint decision making around PPFP and may reduce time for PPFP counseling and method provision. Similar restrictions in PAC inhibit or delay male engagement in counseling and joint family planning decision making.

We highlight several approaches to address these challenges and maximize opportunities for voluntary PPFP and PAFP counseling and services (Table). Optimal voluntary adoption of PPFP and PAFP will be achieved not only through integration during provision of routine maternal and newborn care, but also by integrating family planning into other essential service contacts and outreach mechanisms.

View this table:
  • View inline
  • View popup
TABLE.

Recommendations Related to Integrating Postabortion and Postpartum Family Planning for Diverse Categories of Womena

These recommendations, of course, must be tailored to each unique setting for both logistical and cultural purposes. We also recognize that HCWs, especially in fragile settings, face myriad challenges during normal times which are only exacerbated during this pandemic. We hope HCWs recognize that maximizing opportunities with a client reduces the need for return visits and consequently the risks to themselves and their peers. Also, it enhances care for their clients in that it reduces the need to expose themselves to additional risks associated with separate family planning visits. Adjustments are required not only within health facilities, but throughout the health systems.

Maximizing opportunities with a client reduces the need for return visits and consequently the risks to clients, HCWs, and their peers.

We hope that program managers use the recommendations (Table) to promote these efforts in their communications with HCWs. This will encourage both HCWs and clients to feel safer, regardless of where they are seeking family planning information, products, and services. Thus, a blend of facility-based, community-based, and virtual/telehealth services could be used per setting, as context, health system, and community capacity allow. Additionally, providing clients with timely and accurate anticipatory guidance regarding changes to routine health care services will be essential in supporting their continued access to family planning. We encourage systems to monitor trends in utilization of various services along the continuum of care, at multiple levels, from facility to district to regional to national. We also encourage program managers to recognize HCWs and health facility teams who problem solve and innovate to optimize integration of services and suggest they document and disseminate process improvements and modifications so as to encourage appropriate replication.

LEARNING RELATED TO PAC AND PPFP DURING COVID-19

Providers, policy makers, and those in positions of leadership can rely to some extent on past experiences in complex emergencies such as Ebola, Zika, and humanitarian responses to guide practice and service delivery in the context of the COVID-19 pandemic, but there remains much we do not know. Unique features of this disease can influence care differently than outbreaks of the past. For example, little is known about the impact of COVID-19 on pregnancy and postpartum recovery or the ways women’s and families’ health-seeking behaviors may change in the face of this pandemic. All provider cadres will likely experience a tension between duty of care and self-protection, and what educational messages, training, and protection strategies will work for them remains unknown. Others have highlighted that shifts toward self-care or short-acting contraceptive methods may have ripple effects, hopefully temporary, on the global supply chain for contraception37 that merit close monitoring. It is an imperative of the response community to explore gaps in our knowledge on both the health system and user sides, develop research protocols to generate answers, and document learning to inform ongoing care as COVID-19 continues to be a part of the new global reality (Box).

BOX.

Knowledge Gaps in Postabortion Care and Postpartum Family Planning in COVID-19

General Questions

  • What are the long-term impacts of COVID-19 on pregnancy/pregnancy loss?

  • What is the extent to which COVID-19 affected equity of access to postabortion care (PAC) and postpartum family planning (PPFP) for marginalized and underserved women?

  • What are the unique clinical feature of COVID-19 that may impact clinical care protocols?

  • What contraceptive methods are women choosing during the pandemic (e.g., short-acting, long-acting, sporadic with emergency contraceptive pills)?

  • How are health-seeking behaviors related to maternal and newborn health and family planning care changing in the context of COVID-19? And are there implications/differences in outcomes due to changes in behavior?

  • Does stigma play a role in health-seeking behavior and decision making?

  • What opportunities may exist for intersectoral coordination and linkages across public and private sectors within health and with non-health sectors COVID-19 response efforts (e.g., food distribution)?

Questions Specific to PAC and PPFP

  • How do we communicate to communities about PAC and PPFP during pandemics?

  • What concerns have women expressed about breastfeeding (as this may affect use of Lactational Amenorrhea Method)?

  • What perceptions do providers have of caring for women seeking PAC, women in labor, and for women receiving procedures for long-acting reversible contraceptive methods in the context of COVID-19?

  • What are the opportunities for task shifting these services?

  • What policy changes were made due to COVID-19 to facilitate access to PAC and PPFP? Are these policies temporary or permanent?

LINKAGES BETWEEN RESPONSE ON PAC AND PPFP AND HEALTH SYSTEM RESILIENCE

The emergence of COVID-19 has tested health systems worldwide, both in their management and mitigation of the pandemic directly, but also in their ability to maintain essential services for their populations. The WHO notes in the COVID-19 Operational Guidance for Maintaining Essential Health Services38:

a system’s ability to maintain delivery of essential health services will depend on its baseline capacity and burden of disease

alongside their COVID-19 transmission context. Thus, it is health systems’ resilience—or their capacity to prepare for and effectively respond to crises, maintain core functions when a crisis hits,39 and adapt and transform to function effectively post-pandemic40 —that offers a route to stymie COVID-19’s deleterious effects on essential health services both now and in subsequent waves of the pandemic.

A health system’s resilience could stymie COVID-19’s deleterious effects on essential health services now and in the future.

It is impossible to ignore the threats of not taking action. Based on experience from previous epidemics and health system shocks, we recognize that both family planning and maternal, newborn, and child health (MNCH) care and outcomes also stand to lose ground. One analysis of maternal and reproductive health outcomes estimates that a 10% decline in the use of essential care will result in 1.7 million additional women and 2.6 million additional newborns who will experience major complications as a direct result of care disruptions.41 Further, a 10% decline in modern contraceptive use would result in nearly 50 million additional women with unmet need for contraception.41 Amidst the Ebola outbreak in West Africa in 2014, maternal health stakeholders saw their coverage of ANC, facility delivery, and PNC drop.42 As health seeking patterns amidst COVID-19 appear to echo those witnessed during Ebola, experts estimate a similar, yet more substantial loss now—one which results in hundreds of thousands of additional child and maternal deaths.43

Amidst this gloomy outlook, MNCH programs are managing to provide services because pregnant women still need them. The ability to deliver these services comes in part due to rapid adaptations to provide safe care at community and household levels (including through self-care). Now, more than ever, the clarion call for integration of family planning with essential MNCH care appears: in the context of limited health service accessibility, optimizing every contact to uphold the health, well-being, and interests of women for their health and the health of their families. Simply put, PPFP and PAC integrate services to respond to individuals’ multidimensional needs with an array of simultaneous health interventions (in this case, voluntary family planning linked with maternal and/or infant health care). The health system adaptations we seek now and as we look to the future are both reactive to the moment we live in and an investment in the resilience of the system for the future. Opportunities for integration are central to—and should be capitalized upon—even in the midst of a crisis.

Amidst the gloomy outlook of COVID-19, MNCH programs are managing to provide services because pregnant women still need them.

CONCLUSION

The ability of women, girls, and couples to freely choose the number, timing, and spacing of their pregnancies is a fundamental right and a means to achieve multiple sustainable development goals.44 Global actors have called for family planning to remain on the list of essential services during the COVID-19 pandemic, along with other key maternal, newborn, and child health care services.45,46 PAC and postpartum family planning intersect multiple categories of essential services. Prioritizing integrated service provision now promises to reap returns for improved health and well-being by preventing a rise in closely spaced pregnancies that may require care and burden facilities during subsequent waves of the epidemic. In the months to come, we can cultivate health system resilience by incorporating innovative models of integrated service delivery for pregnant, postabortion, delivering, and postpartum women; securing resources for programs to innovate and sustain services; and seeking partnerships between communities and MNCH programs and across the public and private sectors.

Acknowledgments

The impetus for this article came from a discussion of the FP2020 PPFP/PAFP Steering Committee, which provides strategic guidance to the global postpartum and postabortion family planning movement building on momentum from the 2015 Global PPFP Meeting in Chiang Mai, and continues under the management of the FP2020 Secretariat, with the ultimate goal of supporting progress at the country level.

Disclaimer/Funding statement

The contents are the sole responsibility of the authors and do not necessarily reflect the views of the United States Agency for International Development or the U.S. Government.

Competing interests

None declared.

Notes

Peer Reviewed

First published online: September 17, 2020

Cite this article as: Pfitzer A, Lathrop E, Bodenheimer A, et al. Opportunities and challenges of delivering postabortion care and postpartum family planning during the COVID-19 pandemic. Glob Health Sci Pract. 2020;8(3):335-343. https://doi.org/10.9745/GHSP-D-20-00263

  • Received: June 12, 2020.
  • Accepted: August 18, 2020.
  • Published: September 30, 2020.
  • © Pfitzer et al.

This is an open-access article distributed under the terms of the Creative Commons Attribution 4.0 International License (CC BY 4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are properly cited. To view a copy of the license, visit http://creativecommons.org/licenses/by/4.0/. When linking to this article, please use the following permanent link: https://doi.org/10.9745/GHSP-D-20-00263

References

  1. 1.↵
    1. Ferguson NM,
    2. Laydon D,
    3. Nedjati-gilani G, et al
    . Report 9: Impact of Non-Pharmaceutical Interventions (NPIs) to Reduce COVID-19 Mortality and Healthcare Demand. Imperial College London; 2020. doi:10.25561/77482
    OpenUrlCrossRef
  2. 2.↵
    1. Hall KS,
    2. Samari G,
    3. Garbers S, et al
    . Centring sexual and reproductive health and justice in the global COVID-19 response. Lancet. 2020;395(10231):1175–1177. doi:10.1016/S0140-6736(20)30801-1. pmid:32278371
    OpenUrlCrossRefPubMed
  3. 3.
    United Nations Population Fund (UNFPA). Impact of the COVID-19 Pandemic on Family Planning and Ending Gender-based Violence, Female Genital Mutilation and Child Marriage. UNFPA; 2020. Accessed August 25, 2020. https://www.unfpa.org/sites/default/files/resource-pdf/COVID-19_impact_brief_for_UNFPA_24_April_2020_1.pdf
  4. 4.↵
    1. Rasmussen SA,
    2. Smulian JC,
    3. Lednicky JA,
    4. Wen TS,
    5. Jamieson DJ
    . Coronavirus Disease 2019 (COVID-19) and pregnancy: what obstetricians need to know. Am J Obstet Gynecol. 2020;222(5):415–426. doi:10.1016/j.ajog.2020.02.017. pmid:32105680
    OpenUrlCrossRefPubMed
  5. 5.↵
    1. McGinn T
    . Reproductive health of war-affected populations: what do we know? Int Fam Plan Perspect. 2000;26(4):174. doi:10.2307/2648255
    OpenUrlCrossRef
  6. 6.↵
    1. Kozuki N,
    2. Walker N
    . Exploring the association between short/long preceding birth intervals and child mortality: using reference birth interval children of the same mother as comparison. BMC Public Health. 2013;13(Suppl 3):S6. doi:10.1186/1471-2458-13-S3-S6. pmid:24564713
    OpenUrlCrossRefPubMed
  7. 7.
    1. Rutstein S,
    2. Winter R
    . The Effects of Fertility Behavior on Child Survival and Child Nutritional Status: Evidence from the Demographic and Health Surveys, 2006 to 2012. DHS Analytical Studies No. 37. Rockville, MD: ICF International; 2014.
  8. 8.
    1. Conde-Agudelo A,
    2. Rosas-Bermúdez A,
    3. Kafury-Goeta AC
    . Birth spacing and risk of adverse perinatal outcomes: a meta-analysis. JAMA. 2006;295(15):1809–1823. doi:10.1001/jama.295.15.1809. pmid:16622143
    OpenUrlCrossRefPubMed
  9. 9.↵
    1. London S
    . Mortality Is elevated during infancy and early childhood when births are closely spaced. Int Perspect Sex Reprod Health. 2013;39(4):227–228. Accessed August 25, 2020. https://www.guttmacher.org/sites/default/files/article_files/3922713.pdf
    OpenUrl
  10. 10.↵
    World Health Organization (WHO). Report of a WHO Technical Consultation on Birth Spacing. WHO; 2006. http://www.who.int/maternal_child_adolescent/documents/birth_spacing.pdf
  11. 11.↵
    World Health Organization Department of Reproductive Health and Research (WHO/RHR), Johns Hopkins Center for Communication Programs (CCP). Family Planning: A Global Handbook for Providers (2018 Update). WHO, CCP; 2018. Accessed June 5, 2020. https://www.fphandbook.org/
  12. 12.↵
    1. Cleland J,
    2. Conde-Agudelo A,
    3. Peterson H,
    4. Ross J,
    5. Tsui A
    . Contra-ception and health. Lancet. 2012;380(9837):149–156. doi:10.1016/S0140-6736(12)60609-6. pmid:22784533
    OpenUrlCrossRefPubMed
  13. 13.↵
    World Health Organization (WHO). Programming Strategies for Postpartum Family Planning. WHO; 2013. Accessed August 25, 2020. https://www.who.int/reproductivehealth/publications/family_planning/ppfp_strategies/en/
  14. 14.↵
    High Impact Practices. High Impact Practices in Family Planning. Accessed August 25, 2020. https://www.fphighimpactpractices.org/high-impact-practices-in-family-planning-list/
  15. 15.↵
    High Impact Practices in Family Planning. Post-abortion family planning: a critical component of postabortion care. Accessed August 25, 2020. https://www.fphighimpactpractices.org/briefs/postabortion-family-planning/
  16. 16.↵
    1. Moore Z,
    2. Pfitzer A,
    3. Gubin R,
    4. Charurat E,
    5. Elliott L,
    6. Croft T
    . Missed opportunities for family planning: an analysis of pregnancy risk and contraceptive method use among postpartum women in 21 low- and middle-income countries. Contraception. 2015;92(1):31–39. doi:10.1016/j.contraception.2015.03.007. pmid:25769442
    OpenUrlCrossRefPubMed
  17. 17.
    1. Huber D,
    2. Curtis C,
    3. Irani L,
    4. Pappa S,
    5. Arrington L
    . Postabortion care: 20 years of strong evidence on emergency treatment, family planning, and other programming components. Glob Health Sci Pract. 2016;4(3):481–494. doi:10.9745/GHSP-D-16-00052. pmid:27571343
    OpenUrlAbstract/FREE Full Text
  18. 18.↵
    1. Kidder E,
    2. Sonneveldt E,
    3. Hardee K
    . Who Receives PAC Services? Evidence from 14 Countries. The Futures Group, The Policy Project; 2004.
  19. 19.↵
    1. Nanda K,
    2. Lebetkin E,
    3. Steiner MJ,
    4. Yacobson I,
    5. Dorflinger LJ
    . Contraception in the era of COVID-19. Glob Health Sci Pract. 2020;8(2):166–168. doi:10.9745/GHSP-D-20-00119. pmid:32312738
    OpenUrlFREE Full Text
  20. 20.↵
    World Health Organization (WHO). COVID-19: Resources for pregnancy, childbirth and postnatal care. Accessed June 11, 2020. https://www.who.int/maternal_child_adolescent/links/covid-19-mncah-resources-for-pregnancy-childbirth-postnatalcare/en
  21. 21.↵
    World Health Organization. Q&A: Contraception/family planning and COVID-19. Accessed June 2, 2020. https://www.who.int/emergencies/diseases/novel-coronavirus-2019/question-and-answers-hub/q-a-detail/contraception-family-planning-and-covid-19
  22. 22.↵
    World Health Organization (WHO). Operational Considerations for Case Management of COVID-19 in Health Facility and Community: Interim Guidance. WHO; 2020. Accessed August 20, 2020. https://www.who.int/publications/i/item/10665-331492
  23. 23.↵
    World Health Organization (WHO). Regional Office for Western Pacific. The COVID-19 Risk Communication Package For Healthcare Facilities. WHO; 2020. Accessed August 25, 2020. https://apps.who.int/iris/handle/10665/331140
  24. 24.↵
    Amnesty International. Exposed, Silenced, Attacked: Failures to Protect Health and Essential Workers During the Covid-19 Pandemic. Amnesty International; 2020. Accessed August 25, 2020. https://www.amnesty.org/download/Documents/POL4025722020ENGLISH.PDF
  25. 25.↵
    1. Skibiak JPA
    . A “reality check” on anticipated disruptions to supplies and services resulting from the COVID-19 pandemic. Medium. May 20, 2020. Accessed June 11, 2020. https://medium.com/its-about-supplies/a-reality-check-on-anticipated-disruptions-to-supplies-and-services-resulting-from-the-covid-19-a9c64540181c
  26. 26.↵
    United Nations Population Fund (UNFPA). COVID-19 Technical Brief for Maternity Services. UNFPA; 2020. Accessed August 25, 2020. https://www.unfpa.org/resources/covid-19-technical-brief-maternity-services
  27. 27.
    World Health Organization (WHO). WHO Recommendations on Antenatal Care for a Positive Pregnancy Experience. WHO; 2016. Accessed August 25, 2020. https://www.who.int/reproductivehealth/publications/maternal_perinatal_health/anc-positive-pregnancy-experience/en/
  28. 28.
    World Health Organization (WHO). Advice on the Use of Masks in the Context of COVID-19: Interim Guidance-2. WHO; 2020.Accessed August 25, 2020. https://apps.who.int/iris/rest/bitstreams/1279750/retrieve
  29. 29.
    World Health Organization (WHO). Infection Prevention and Control During Health Care When COVID-19 Is Suspected. WHO; 2020. Accessed August 25, 2020. https://www.who.int/publications-detail/infection-prevention-and-control-during-health-care-when-novel-coronavirus-(ncov)-infection-is-suspected-20200125
  30. 30.
    International Federation of Red Cross (IFRC); United Nations Children’s Fund (UNICEF); World Health Organization (WHO). Social Stigma Associated with COVID-19; A Guide to Preventing and Addressing Social Stigma.; IFRC, UNICEF, WHO; 2020. Accessed August 25, 2020. https://www.who.int/who-documents-detail/a-guide-to-preventing-and-addressing-social-stigma-associated-with-covid-19
  31. 31.
    World Health Organization (WHO). Advice on the Use of Point-of-Care Immunodiagnostic Tests for COVID-19. WHO; 2020. Accessed August 25, 2020. https://www.who.int/publications-detail/advice-on-the-use-of-point-of-care-immunodiagnostic-tests-for-covid-19-scientific-brief
  32. 32.
    World Health Organization (WHO). Guiding Principles for Immunization Activities During the COVID-19 Pandemic. WHO; 2020. Accessed August 25, 2020. https://www.who.int/publications-detail/guiding-principles-for-immunization-activities-during-the-covid-19-pandemic-interim-guidance
  33. 33.
    High Impact Practices. Family planning and immunization integration: reaching postpartum women with family planning services. Published July 2013. Accessed August 25, 2020. https://www.fphighimpactpractices.org/briefs/family-planning-and-immunization-integration/
  34. 34.
    International Federation of Red Cross (IFRC); United Nations Children’s Fund (UNICEF); World Health Organization (WHO). RCCE Action Plan Guidance; COVID-19 Preparedness & Response. IFRC, UNICEF, WHO; 2020. https://www.who.int/publications-detail/risk-communication-and-community-engagement-(rcce)-action-plan-guidance
  35. 35.
    World Health Organization (WHO); United Nations Children’s Fund (UNICEF). Community-Based Health Care, Including Outreach and Campaigns, in the Context of the COVID-19 Pandemic. WHO, UNICEF; 2020. Accessed August 25, 2020. https://www.who.int/publications-detail/community-based-health-care-including-outreach-and-campaigns-in-the-context-of-the-covid-19-pandemic
  36. 36.
    World Health Organization (WHO). Caring for women subjected to violence: A WHO curriculum for training health-care providers. Published online 2012. https://www.who.int/reproductivehealth/publications/caring-for-women-subject-to-violence/en/
  37. 37.↵
    1. Weinberger M,
    2. Hayes B,
    3. White J,
    4. Skibiak J
    . Doing things differently: what it would take to ensure continued access to contraception during COVID-19. Glob Health Sci Pract. 2020;8(2):169–175. doi:10.9745/GHSP-D-20-00171. pmid:32561528
    OpenUrlFREE Full Text
  38. 38.↵
    World Health Organization (WHO). Maintaining Essential Health Services: Operational Guidance for the COVID-19 Context (Interim Guidance 1 June 2020). WHO; 2020. Accessed August 25, 2020. https://www.who.int/publications/i/item/10665-332240
  39. 39.↵
    1. Kruk ME,
    2. Myers M,
    3. Varpilah ST,
    4. Dahn BT
    . What is a resilient health system? Lessons from Ebola. Lancet. 2015;385(9980):1910–1912. doi:10.1016/S0140-6736(15)60755-3. pmid:25987159
    OpenUrlCrossRefPubMed
  40. 40.↵
    1. Blanchet K,
    2. Nam SL,
    3. Ramalingam B,
    4. Pozo-Martin F
    . Governance and capacity to manage resilience of health systems: towards a new conceptual framework. Int J Health Policy Manag. 2017;6(8):431–435. doi:10.15171/ijhpm.2017.36. pmid:28812842
    OpenUrlCrossRefPubMed
  41. 41.↵
    1. Riley T,
    2. Sully E,
    3. Ahmed Z,
    4. Biddlecom A
    . Estimates of the potential impact of the COVID-19 pandemic on sexual and reproductive health in low- and middle-income countries. Int Perspect Sex Reprod Health. 2020;46:73–76. doi:10.1363/46e9020. pmid:32343244
    OpenUrlCrossRefPubMed
  42. 42.↵
    1. Sochas L,
    2. Channon AA,
    3. Nam S
    . Counting indirect crisis-related deaths in the context of a low-resilience health system: the case of maternal and neonatal health during the Ebola epidemic in Sierra Leone. Health Policy Plan. 2017;32(suppl_3):iii32–iii39. doi:10.1093/heapol/czx108. pmid:29149310
    OpenUrlCrossRefPubMed
  43. 43.↵
    1. Roberton T,
    2. Carter ED,
    3. Chou VB, et al
    . Early estimates of the indirect effects of the coronavirus pandemic on maternal and child mortality in low- and middle-income countries. Lancet Glob Health. 2020;8(7):e901–e9088. doi:10.1016/s2214-109x(20)30229-1. pmid:32405459
    OpenUrlCrossRefPubMed
  44. 44.↵
    1. Starbird E,
    2. Norton M,
    3. Marcus R
    . Investing in family planning: key to achieving the sustainable development goals. Glob Health Sci Pract. 2016;4(2):191–210. doi:10.9745/GHSP-D-15-00374. pmid:27353614
    OpenUrlFREE Full Text
  45. 45.↵
    World Health Organization (WHO). Gender and COVID-19; Advocacy Brief. WHO; 2020. Accessed August 25, 2020. https://www.who.int/publications-detail/gender-and-covid-19
  46. 46.↵
    1. Townsend JW,
    2. ten Hoope-Bender P,
    3. Sheffield J
    . In the response to COVID-19, we can’t forget health system commitments to contraception and family planning. Int J Gynaecol Obstet. Published online May 16, 2020. doi:10.1002/ijgo.13226. pmid:32415990
    OpenUrlCrossRefPubMed
PreviousNext
Back to top

In this issue

Global Health: Science and Practice: 8 (3)
Global Health: Science and Practice
Vol. 8, No. 3
September 30, 2020
  • Table of Contents
  • About the Cover
  • Index by Author
  • Complete Issue (PDF)
Print
Download PDF
Article Alerts
Sign In to Email Alerts with your Email Address
Email Article

Thank you for your interest in spreading the word about Global Health: Science and Practice.

NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. We do not capture any email address.

Enter multiple addresses on separate lines or separate them with commas.
Opportunities and Challenges of Delivering Postabortion Care and Postpartum Family Planning During the COVID-19 Pandemic
(Your Name) has forwarded a page to you from Global Health: Science and Practice
(Your Name) thought you would like to see this page from the Global Health: Science and Practice web site.
CAPTCHA
This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
Citation Tools
Opportunities and Challenges of Delivering Postabortion Care and Postpartum Family Planning During the COVID-19 Pandemic
Anne Pfitzer, Eva Lathrop, Alison Bodenheimer, Saumya RamaRao, Megan Christofield, Patricia MacDonald, Bethany Arnold, Neeta Bhatnagar, Erin Mielke, Meridith Mikulich
Global Health: Science and Practice Sep 2020, 8 (3) 335-343; DOI: 10.9745/GHSP-D-20-00263

Citation Manager Formats

  • BibTeX
  • Bookends
  • EasyBib
  • EndNote (tagged)
  • EndNote 8 (xml)
  • Medlars
  • Mendeley
  • Papers
  • RefWorks Tagged
  • Ref Manager
  • RIS
  • Zotero
Share
Opportunities and Challenges of Delivering Postabortion Care and Postpartum Family Planning During the COVID-19 Pandemic
Anne Pfitzer, Eva Lathrop, Alison Bodenheimer, Saumya RamaRao, Megan Christofield, Patricia MacDonald, Bethany Arnold, Neeta Bhatnagar, Erin Mielke, Meridith Mikulich
Global Health: Science and Practice Sep 2020, 8 (3) 335-343; DOI: 10.9745/GHSP-D-20-00263
del.icio.us logo Digg logo Reddit logo Twitter logo CiteULike logo Facebook logo Google logo Mendeley logo
  • Tweet Widget
  • Facebook Like
  • Google Plus One

Statistics from Altmetric.com

Jump to section

  • Article
    • Abstract
    • INTRODUCTION
    • WHY FOCUS ON FAMILY PLANNING WITHIN SERVICES FOR PREGNANT, POSTABORTION, AND POSTPARTUM WOMEN NOW?
    • PRACTICAL APPROACHES AND MODIFIED FAMILY PLANNING SERVICE DELIVERY MODELS FOR DIVERSE POSTABORTION AND POSTPARTUM CLIENTS
    • LEARNING RELATED TO PAC AND PPFP DURING COVID-19
    • LINKAGES BETWEEN RESPONSE ON PAC AND PPFP AND HEALTH SYSTEM RESILIENCE
    • CONCLUSION
    • Acknowledgments
    • Disclaimer/Funding statement
    • Competing interests
    • Notes
    • References
  • Figures & Tables
  • Supplements
  • Info & Metrics
  • Comments
  • PDF

Related Articles

  • PubMed
  • Google Scholar

Cited By...

  • Contraceptive dynamics during COVID-19 in sub-Saharan Africa: longitudinal evidence from Burkina Faso and Kenya
  • Google Scholar

More in this TOC Section

  • The Case for Using a Behavior Change Model to Design Interventions to Promote Respectful Maternal Care
  • Oxygen Inequity in the COVID-19 Pandemic and Beyond
  • Does the Current Global Health Agenda Lack Vision?
Show more COMMENTARY

Similar Articles

Subjects

  • Health Topics
    • COVID-19
    • Family Planning and Reproductive Health
    • Infectious Diseases
    • Maternal, Newborn, and Child Health
    • Postabortion Care
US AIDJohns Hopkins Center for Communication ProgramsUniversity of Alberta

Follow Us On

  • Twitter
  • Facebook
  • LinkedIn
  • RSS

Articles

  • Current Issue
  • Advance Access Articles
  • Past Issues
  • Topic Collections
  • Most Read Articles
  • Supplements

More Information

  • Submit a Paper
  • Instructions for Authors
  • Instructions for Reviewers
  • GH Journals Database

About

  • About GHSP
  • Advisory Board
  • FAQs
  • Privacy Policy
  • Contact Us

© 2023 Creative Commons Attribution 4.0 International License. ISSN: 2169-575X

Powered by HighWire